99100106 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPF.RTINO BUILDING.ELRCTRICD,
BUILDING DIVISION APPIACATIONIPF,RNIIT PLUMBING-MECHANICAL.
BUILDING PROJECT IDENTIFICATION
BUILDING N�IIRESS,. SANITARY NO. APPLICATION SUBMITTAL DAIV
ez-
08NERS NA E HONE,:r/ CONIG,Cr R'S NAME: �7 LIC NOp
f.i us, 7P.2
y(F�� ^ ��J'' 6 //��� oQ�r3 NC CDIYfRDI.II
4RCHITEMDENGINEER: LIC NO AD/ / 2.C. ��(rc�p Q (l4✓�. J'�. ❑
CONTACT: PHONE BUILDING PERMIT INFO
"` ` �r��1 s � y ❑ Conwlw.t Fec9 Paid by ApplitlNl(Initial) HLDG ELECT' PI. I MEGA
LICENSED CONTRACTORS DECLARATION QTY ELECTRIC PERMFF FEE
I Thereby ofnno that I am i1cmed mile, poli I mf Cnapn 9(Onamelainc JOB DESCRIPTION
O�Z wirhSmun]1001 of Dlvlsim Jnf to Omin,sn tan RnfeFsimsCde.md mylicen.a is RFSIDENTIAL.'
LL1 O O PERMIT ISSUANCE
t-�_ In full form am eRml. p3 ❑SFUN'1. ❑KITCHEN REMODEL
a1..UzV Liacn.¢Cies. Lica APPLIANCES-RISIDGNTIAL El ADDITION C1 PLUMBING RE-PIPE
y Q Date
1 Cimllp:l(N
yFOtL RCHfIECTS DECLA ATION PANELS ❑MULTIUNIT ❑STRUCTURAL
P!�AZ I uMcluuul my Plans shill he mN ulrublic rettrdF MODIFICATION
OZZ;JO UP TO 200 AMPS E]INTERIOR El CHIMNEY REPAIR
1-.I:tW LicrnaJ Ftnfcuiorul 201-I000AMPS IMPROVEMENT SWIMMING PX)IS
iK W� I herel+y affirm Lha I.m n� OWNER BUILDERexerox fro n sh,ComrsOm's I.rrae Law for the DECLARATION OVER IOW AA{I'S BAER E510UEIlRE.PA IoRn�DFJSIO1.RjON
x 6 U following_oo LStttian 00315.Hu me.,"Pocf.inns Cade:Any 61,or'.1, SIGNS ELIiCDUCAL '4Mr(
3 V- whieh requite a parmn nt rmrwmc.ale,impmro,JcmnIIM,or r,Peir arty Ftrtsewm
E'LL'0g 'norm I.coaa.rcc,alw rtyuirtsnk vpPlw-enl forsecn piconao fik.6medratcnmal SPECIAL CIRCUMMISC. -
Ythat The In faceted Famm nl to the,povisiwc of the Comrveux s Liceme law(Chapter 9 ...
�aa C, (commerical,with W
Saxion JO)of Dlvl,fm 3 ormmMP.
a Besinsamd l'mfeaims Cukpr TEMET ER OR POLE INST. COMMERCIAL:
d d tut he is e.mmp Ilvefrum mIJ the basis for the alleged exemption.Any violanoir of ❑NEW BLEGIAUDTTION ❑DFNOLRION
� N Seclian W315 by any.,Or.f«.Irmsitwhiten,lhert'licam to.dot foally of T'ON'ER DEVICES [ITENANT ❑FOOUSERVICE
,yCmot mons,than live hamlrN duller(5]10). IMPROVEMI!NT
Q Lcsowneoflhcprryeny,Thr mSWIMMING POOL ELECTRIC
y�e
will the wand lie slmnme in not inneMN or offered fur enle(5,,,.]044,Banire,s ❑OILIER
ll do
Iy 3 w aril pmfeaiuu Code:The Comuscoris Liam.Law docs mor apply In on cancer of OUTLETS-SWITCHES-FIXTURES
popcny win thold,of improves thelaw,and wlm docs weh work Idm¢Ifor through
Fit,own employ,I ro,ide]that mach imlinocnema are mr imerdcd or ffcrt1 for NEW RESIDENTIAL ELEMPR Q F1'
nal,IL loaner,the builem,mm
iPrmxlllead w
n in soithin arc Year of nxnpininn.FineSQ.FI'.Fl-OGRAREA S'SQ.IT
rcr-huillkr wit have tie bunko of pmviag m.t Ile did m wid w impo.<fm pu-
In,ne ar,ala.).
❑ I.a9,weer of the paper,,am CxelT trot contracting halm heaawd mmencn, l-
coma,Lv the pmnotl(Sec.t,an 'r e,or ra,Py inan Bas i alcm jrTnee Commence',Li-
nnctawtlamnot apply
,rjct,a ith.1.fpoptny in an buildsmimpm.e Cmancmud QTY. PLUMBING PERMIT FEE
who rnnlru'L fnt,ucM1 pmjnkr with a camnctorte)I IttYL W Innuanl to the Conuw'lar'n
Lt.law. . PERMIT ISSUANCE
1 am exempt nmkr Sec. .B&P C for Ni,won
ALTER-DRAIN&VIM-WATER IIA) VALUATION
Ow Talc
WORKE'R'SC
J f 54T10N DECLARATION
BACK ROW PROTECT.DEVICE
Ihnchym �retityoLeofhfoloing tions:
IM1vcad will ainue.aCrnifimm TCat In¢If-imurt f«WmI,,,hGmen-
DRAINS-FLOOR.ROOF AREA,GOND. y U ius TYPE COVSORUCI'ION
ex Omvided Gr by Goblet TW of the Lal+o ctde.rtx me perfmmnca ar dw
work Pur whkn Irvin pamil is isued. IgxNRES-PER TRAP
❑I have arld wit maintain Worker,Compcnsatien Imsnree,as required by Secran
391X1 of the labor Code,for tre PerGrnhamr of me wort,for which this p nit is Jawed. GAS-EA.SYSTES -I INC.40lI1IJ31'S OCC GROUP A
MyWaoar Ip1 amnnttC MPuTO
Carrie4 Policy' O�,SO SL GAS-rA.SYSTFJNPVER 41En)
CERUI CSTE OF I Wvle"ON TROM WORKERS' GµIASF%INDU.TTHL WASTE IM1iRCRl'1'OR /
COMPENSATION INSURANCES BUILDING DIVISION FEES
This seaced mx be cmrminul if thenrvl pein for me hundred dollav(S I WI GREASETRAP
or can.)) vion PIANCI IF,CK CFE
I cen try brain the perfumwnee ofrh work for wlfich this permit is issted.I•lull SEWER-SANITARY-STORM EA,200 IT.
not ertmloy i n,lcrum in any munrcnn as to M1ccan a aa*,'m theWrrkcr5 ComPert ENERGY FliE
O Z Nation lawn of Criifornia.Earn, WA117R DEALER WNENDELIE112 GRADING IFF
Z O AprAicann
(A NOTICE TO APPLICANT.If,after making this C Fbicue at Enempion,you shard WATER SYSTE\VIItEATING
6F$ ? bnnrlle nuti m the W'nrkrr's Com tMm f the IaMr Ct.k,you mast SOILS EIRE
pct pcnw ptovisiumo
Fk7
forthwith csmllRY with...h povisiau tr Ni,perminsMll he dnrrrd resnked. WATER SERVICE
a �
CONSTRUCTION LENDING AGENCY NEW RESIDENTIAL PI NH. 5Q.FT. PAID
UO kfor wallithitl exam i isamnarveli30M.0 g Cgcncy forthelrrhrnumcof Uae RaeipM
to wok for which this permit is isslyd IStt.YN"!.Civ.C.)
OU 1<adefs Name 'T'OT'AL '1 GTN,:
Isrdcr's Addrexs
W BUILDING LIG
I C[Illrr that 1 hive roil 11 o appl1C coup endnine,lbaty o tureen me aMVa iw lawn
W Ilan IF
F,lZ cunnL lagreemmmply wish Jl viryni,cuwlyarsiamlmud halt l.melatem,Ito QTY, MECHANICAL PERMIT FEE
U Z lmidmg n,n.trm:aa,.and nerebr,,tart,rrpmrentuivn armindtywenerapan tn< MDSMIC FEES
.1,ovementiimed prulcny for inrpcelinn p r,ot n PERMIT ISSUANCE
(We)agree to ase,irdmify,aNeep
cakhum .a lethe City of Culrnim again. Iil,ECIHIC ITE
Iiabililie.judgmeat,.ro,ts.rdexpemes which may in any wayaarvcagaimt stud City ALTER OR ADD 11)MECH.
PLUMBING IEE
in wscquerce of the g—an,of this permit.
APPLICANT UNDHRNTANDS AND WILT,COMPLY WITH ALI,NON-POINT AIR I IANULING UNIT(1010.01O CEM)
MECHANICAL I
SOURCERF TIONS. FF.
/D/t4 ALR HANDLING UNIT(OVER 10,000 CFM) CONS'I'RUM[ON TAX
SignStum ofA tmnUCanmw1cr ! Dae EXHAUST HOLD(W/DUCT) HOUSING MITIGATION FEE
HA]ARIXIUS MATERIALS DISCLOSURE
Willthc applieanl or future building recupvnl tortorft dle hnaMvls matvial HEATING UNIT(TO 101.000 BTU)
an dcfnM by the Cuprnirm Municipal Calc,Chapter 9.12,and be health tett Safe,
Code.Smfoa 255321.)^ HEATING UNIT(OVER IOO.tt10 RTL)
Yet Nn
E3 VIiM'IfAf1UN PAN(SINGLE RESIU) PAID '
Will,the applimnl or foram haildln Date Receipt Is
gby be IT um Airenl or dcviccn whish BOILER-COMP f3HP OR 10.00 BTU)
til haurdws air crmlWainasF m dcfind by be Noy Atm Air IJunitY Mwgemcnt
iraicl^. TOTAL:
❑Yu FIN. BOILI!R-COMP(OVL'N IIg1.0g1 B'N)
I have rad the,h.rudaua mancrials5, mx urlM Clnlqu M1.95 oflhe Ci- AIR CONDITIONER - ISSUANCE DATE:
l i 533
Erode Ido-,&Safety Code.Snvivm 8505,25533 acrd 853f.Iaaderetud dN if Fin, Ntw RES]DENTIAL..N T:CH. 5p.PT.
oD,,ng Jiti,mule yM1avculetWnl.lhel it it mY rmpm.ihilitywmlify mvpvt
o(Ihc lcquvc mast be mer pirmissuarccofa Ccnificafu of. patLLy. C/ LTi
(Teter a 'x00 tale TOTAL: ISSUED tlY:
OFFICE
99100106
• 19742 DRAKE CT BATHROOMS BY REMODELING SPEC 10/20/1999
THOMPSON CHARLES F AND KAY E 1422 SARATOGA AVE
SAN JOSE, CA 95129
SINK REPLACEMENTS
1
31632015.00
106 - SEWER & WATER
202 - UNDERFLOOR PLUMBING
301 - ROUGH PLUMBING
302 - TUB & OR SHOWER
502 - FINAL PLUMBING ENERGY
506 - GAS TEST
507 - FINAL PLUMBING
•
•
INVOICE IN'.[OICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE
CITY OF CIPERTINO V <
BUILDING PERMIT INVOICE OPERATOR: chrletya
Sec: Twp: Rng: Sub: Blk: Lot:31632015.00
INVOICE DATE......: 10/20/1999
REFERENCE ID k ...: 99100106
SITE ADDRESS .. . . .: 19742 DRAKE Cr
SUBDIVISION ... .. . .
CITY .......... . . . : CUPERTINO
IMPACT AREA ...... .
OWNER ......... .. . : THOMPSON CHARLES F AND KAY E
ADDRESS .......... : I
CITY/STATE/ZIP ... : CUPERTINO CA, CA 95014-2432
CONTRACTOR .......: POND, HERB LIC # 20767
COMPANY . . . . . .....: BATHROOMS BY REMODELING SPEC
ADDRESS .. . . . ..... : 1422 SARATOGA AVE
CITY/STATE/ZIP ...: SAN JOSE, CA 95129
TELEPHONE . . . .....: (408)328-6700
FEE DESCRIPTION CHK TOTAL FEE PAID-TO-DATE BALANCE DUE
--------------- --- --------- ------------ -----------
BPFIXTURE P 24.99 0.00 24.99
PPERMITFEE P 35.52 0.00 35.52
60 51 0.00 60.51
V ID ._-DESCRIPTION---_-___. VOICE ID DESCRIPTION
.. ..... ........ .....................e......
SEWER I WATER 202 UNDERFLOOR PLUMBING
301 ROUGH PLUMBING 302 TUB 6 OR SHOWER
502 FINAL PLUMBING ENERGY 506 GAS TEST
507 FINAL PLUMBING